The conversion of pyruvate to acetyl CoA by the pyruvate dehydrogenase complex is a key step in the liver in particular, as it removes any chance of conversion of pyruvate to glucose, or as a transmination substrate. It commits pyruvate to entering the citric acid cycle, where it is either used as a substrate for oxidative phosphorylation, or is converted to citrate for export to the cytosol to serve as a substrate for fatty acid and isoprenoid biosynthesis.

The oxidative decarboxylation of pyruvate in anaerobic organisms differs from the aerobic process in that the electron acceptor is an iron-sulfur protein, not NAD+. The conversion is catalyzed by a thiamine-dependent enzyme that also acylates coenzyme A.[3] The reducing equivalents are disposed of by the production of H2 via hydrogenase.